Basal Cell Ca, Squamous Cell Ca, and Melanoma - PowerPoint PPT Presentation

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Basal Cell Ca, Squamous Cell Ca, and Melanoma

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Melanoma Staging/Dx. Tumor thickness (Breslow) Ulceration. Number of metastatic LNs ... Melanoma- Late mets, 'great mimicker', no shave biopsy ... – PowerPoint PPT presentation

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Title: Basal Cell Ca, Squamous Cell Ca, and Melanoma


1
Basal Cell Ca, Squamous Cell Ca, and Melanoma
  • Jeanette Prante, MS3

2
Normal Skin Histology
3
Basal Cell CA
  • Older individuals
  • Sun-exposed areas
  • Irregular exposure to sun
  • Small, well-circumscribed pearly tan-gray papule
    with telangiectasia
  • Enlarges
  • Ulcerates (rat tooth)

4
(No Transcript)
5
Nevoid BCC Syndrome/BC Nevus Syndrome/Gorlin
Syndrome
  • AD (PTCH)
  • Multiple BCCs
  • lt20 years
  • Other tumors
  • Ovarian fibromas
  • Medulloblastomas
  • Cleft lip/palate, rib/vertebral abnormalities
  • Pits soles, palms

6
Diagnosis BCC
  • Shave bx
  • Excisional bx
  • Small lesion
  • Multiple skin cancers

7
Melton J. Dec 1996. Loyola University Dermatology
Education Website. lthttp//www.meddean.luc.edu/lum
en/MedEd/medicine/dermatology/melton/content1.htmgt
Assessed Mar 2007.
8
Treatment BCC
  • Surgical
  • Primary excision
  • Mohs surgery
  • Destructive
  • Electrodessication/curretage
  • Cryosurgery
  • Laser phototherapy
  • Medical
  • Radiotherapy

9
Metastasis
  • RARE!
  • When happens, lesion advanced

10
Squamous Cell Carcinoma
  • Malignancy of epidermal keratinocytes
  • Mengt60
  • Sun-exposed areas
  • Solitary, slowly enhancing indurated nodule
  • Central ulceration

11
Ray T. 2005 Sept. lthttp//tray.dermatology.uiowa.
edu/Home.htmlgt Assessed Mar 2007
12
SCC Risk Factors
  • Solar irradiation (UVA/B)
  • Number of lifetime burns
  • X-ray therapy
  • Carcinogens (tars, oils)
  • Hereditary diseases
  • Xeroderma pigmentosa
  • Albinism
  • Actinic keratoses, HPV, burn scars

13
Diagnosis SCC
  • Shave bx
  • Excisional bx
  • Small lesion
  • Multiple skin cancers

14
UCSF School of Medicine Dermatology Glossary.
lthttp//missinglink.ucsf.edu/lm/DermatologyGlossar
y/squamous_cell_carcinoma.htmlgt Assessed March
2007.
15
Treatment SCC
  • Surgical
  • Primary excision
  • Mohs surgery
  • Destructive
  • Electrodessication/curretage
  • Cryosurgery
  • Laser phototherapy
  • Medical
  • Radiotherapy

16
Metastasis
  • More likely on ears, scalp, nostrils, extremities
  • Overall 1-2
  • More likely with larger (2 cm), deeper lesions (4
    mm)

17
Malignant Melanoma
  • Asymmetric, irregularly-pigmented lesions with
    ill-defined borders
  • gt4 mm (gt10mm)
  • MgtF
  • Agegt50

18
Ray T. 2005 Sept. lthttp//tray.dermatology.uiowa.
edu/Home.htmlgt Assessed Mar 2007
19
Risk Factors
  • UV light
  • Sun lamps before age 25
  • Light-colored skin
  • Freckling
  • Moles
  • gt50
  • h/o dysplastic
  • Congenital
  • Family history

20
Growth Patterns
  • Superficial spreading- MC
  • Nodular- aggressive, vertical growth
  • Lentigo Maligna- slow growth, rarely metastasize
  • Acral Lentiginous- More common in non-Caucasians,
    soles/palms, subungal

21
Conti I. Sept 2001. Histology.
lthttp//www.xiphophorus.org/pathology.htmgt
Assessed Mar 2007.
22
Melanoma Staging/Dx
  • Tumor thickness (Breslow)
  • Ulceration
  • Number of metastatic LNs
  • DX with incisional/excisional bxs
  • Sentinal node bx

23
Treatment
  • Narrow excisional bx
  • Wide local excision
  • Excision deep fascia inc. risk of mets
  • Adjuvant- risk for distant mets
  • Immunotherapy
  • Chemotherapy

24
Recurrence/Mets
  • Most likely local recurrence
  • Late recurrence gt10 yrs, 25
  • Mets- MC skin, subcutaneous tissue, LNs
  • ? Primary

25
The BIG Picture
  • Those at risk for all 3
  • UV radiation- prevention key
  • Basal Cell- Rarely metastasizes, nests of cells,
    MC skin cancer
  • Squamous Cell- Can metastasize, Keratin pearls
  • Melanoma- Late mets, great mimicker, no shave
    biopsy
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